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72 Cards in this Set

  • Front
  • Back
For peripheral vascular disease what are the primary reasons why wounds won't heal
inadequate vascular supply
Excessive pressure
inadequate nutritional support
Describe peripheral vascular disease (functional type)
don't have an organic cause, don't involve defects in blood vessels' structure, usually short term effect related to "spasm" that may comeand go (Raynaud's disease)
Describe peripheral vascular disease (organic type)
peripheral vascular diesease are caused by structural changes in the blood vessels (inflammation and tissue damage)
what is the purpose of lymphatic system
removes waste/toxins
maintain fluid balance (via transport)
what types of patients are at a higher risk for PAD
<50 with diabetes and one other atherosclerosis risk factor,
50-69 with hx of smoking or diabetes
age 70 years and older
Leg symptoms with exertion (claudication) or ischemic rest pain
abnormal lower extremity pulse examination
Known atherosclerotic coronary, carotid, or renal arterial disease
What are the symptoms of PAD
asymptomatic
intermittent (classic) claduication
arterial leg symtpoms
critical limb ischemia
What is intermittent claudication a result of
result of inadequate arterial bloody supply to the exercising muscles
what symptoms occur due to intermittent claudication
aching or cramping in calves that occurs with walking but subsides with rest
what relieves intermittent claudication
relieved by standing/dependent position of lower extremities
How can you bring on the symptoms to confirm intermittent claudication
elevation will bring on pain because decreases blood flow q
what are other causes of arterial insufficiency
acute obstruction
vasospasm
vasculitis
what is the most precipitating event for arterial ulceration
trauma
Clinical features of arterial ulcerations:
Locations
distalsites; toes, lateral malleolus, dorsal surfaces/exposed to small traumas
Clinical features of arterial ulcerations:
wound bed and edges
pale; dry with little drainage
"punched out" clearly defined margins
necrosis, eschar or gangerne common
poor epithelial migration
Clinical features of arterial ulcerations:
pain
wound site or lower limb
pain elevation of limbs; relief with dependent position
intermittent claudication
Clinical features of arterial ulcerations:
limb characteristics
thin with muscle atrophy; pale skin appearance, decrease distal hair growth, thickened toe nails, poor skin turgor, cool to palpation
Clinical features of arterial ulcerations:
basic clinical test results
distal pulses are diminished or absent
rubor or dependency (+),
capillary refill > 3 seconds
venous filling time > 15 seconds
ABI: less than or equal to 0.8
What are the diagnostic tests for arterial ulcerations
ABI and/or toe brachial index (TBI)
Transcutaneous partial pressure of oxygen
Segmental doppler ultrasonography
duplex doppler imaging
angiography
what does the following measurement mean for ABI:
>1.30mmHg
noncompressible
what does the following measurement mean for ABI:
1.0-1.29mmHg
normal
what does the following measurement mean for ABI:
0.91-0.99mmHg
borderline
what does the following measurement mean for ABI:
0.41-0.90mmHg
mild to moderate
(arterial insufficiency, intermittent claudication)
what does the following measurement mean for ABI:
0.00-0.40mmHg
severe PAD
(arterial insufficiency, intermittent claudication)
PT examination for arterial ulcer
wound examination, adjacent skin condition, tests for arterial insufficiency, pain, edema (CHF), sensation (numbness, tingling), ROM of toes, ankle, hip, strength of foot, ankle, knee, hip, footwear, functional mobility, gait analysis
how do you test claudication time
1 mile per hour on level treadmill
what is surgical revascularization
arterial bypass graft that can happen aortoiliac, aortafemoral, femoropopliteal, femorodistal, balloon angioplasty/endarter ectomy
amputation
what are the components of ulcer management
local wound care
limb protection
risk factor reduction
When should eschar be debride
when it is NOT adhered
How do you handle a wound if you are worried about revascularization
need to keep the wound dry
how do you handle a wound if the pt has already had a revascularization
need to keep moistened.
PT treatment for arterial ulcer management
manage ulcer
educate patient/caregivers
prescribe progressive walking
program
Education on skin care
moisturize dry skin
avoid soaking of feet
seek professional help for nail and callus trimming
choose appropriate footwear
where do you want patients to eventually be with the progressive walking program
30 min, 3X week, 6months, proven to decrease symptoms of intermittent claudication
What is chronic venous insufficiency
occurs because of the inability of the venous system to efficiently return blood to the heart from the lower extremities
What causes CVI
sustained venous hyptertension (elevated ambulatory venous pressure)
Increased capillary hydrostatic pressure and permeability resulting from: altered venous return
decrease in venus return due to
increased venous dilation
valvular deficiency muscle pumping
When serous fluid protein, fibrin and blood cells move from veins to the tissue what may result
interstitial edema
brawiness= leakage of protein into interstitial space with resultant fibrosis
What causes hemosiderin
enzymes break down RBS, which causes a brownish-yellow discoloration of tissue
what can cause high ambulatory pressure
venous valve incompetence
deep vein obstruction/thrombosis
ateriorvenous fistual
calf muscle pump failure
what are risk factors for venous insufficiency
a family history of maternal venous insufficiency
a history of DVT, DM, chronic heart failure, or recent edema
obesity
severe trauma to the leg
vigorous exercise
number of pregnancies
Clinical features of venous ulcerations:
Location
proximal to medial malleolus (most common)
Clinical features of venous ulcerations:
wound bed and edges
shallow, irregularly shaped, erythematous borders, excessive exudate, wound bed can contain fibrous yellow slough
Clinical features of venous ulcerations:
Pain
mild to moderate, describe as heaviness or aching.
Worse when standing, relieved with elevation of legs
Clinical features of venous ulcerations:
limb characteristics
edema (hallmark sign)
hemosiderin staining, indurated,
dilated superficial veins
Clinical features of venous ulcerations:
basic clinical test results
distal pulse are present
Why is it important for a PT to know what caused the edema
The typical treatment for edema is compression. IF the patient has congestive heart failure and you put compression on the extremity, it can make the condition worse
What are the diagnositc tests for chronic venous insufficiency
Doppler and Duplex Ultrasound, Contrast Venography
what are the test and measure for PT Exam
Wound examination
adjacent skin condition
tests for arterial insufficency (-)
pain
EDEMA**
sensation (No major deficiencies)
ROM of toes, ankle, knee, hip
Footwear
functional mobility, gait analysis
Management of venous ulcers
compression is the mainstay of management of venous ulcers
why is compression the mainstay of dealing with venous ulcer
compression reduces venous hypertension by blocking transcapillary flow during contraction, thereby increasing the flow out of deep veins
what are the key components of ulcer management
local wound care
limb protection
risk factor reduction
what type of dressing do you use yellow slough
autolytic debridement with hydrocolloid dressing
T/F: Ulcers tend to be moist
True so need to use highly absorbant dressing
PT treatment for venous ulcer
mananger ulcer
educate patient/caregivers
reduce edema
increase aerobic activity
Describe the skin care before ulceration generally speaking
wash intact skin daily with mild soap and water, dry thoroughly, and apply moisturizing cream
Describe the skin care before ulceration dry skin
dry, itching skin can be managed by rubbing mineral oil into intact skin, covering with saran wrap to seal in oil, putting on cotton socks and sleeping with it on, removing it in morning followed by washing and drying in the skin well, then applying moisturizing cream. Once a week
what are the ways you can reduce edema
exercise (ankle pumps and toe motions)
Elevation (knees higher than hip, ankles higher than knees), 20-30 min 3-4X/day
Compression need 40mmHg or ankle graduating to 12-17mmHg at knee
How many mmHg does the following provide?
TED hose
18mmHg
How many mmHg does the following provide?
Elastic wrap
24mmHg
How many mmHg does the following provide?
Support stockings
30-40mmHg
Compression support:
Classification I
mild pressure (15-20 mmHG)
Compression support:
Classification II
moderate pressure (20-30 mmHg)
Compression support:
Classification III
strong pressure (30-40 mmHg)
Compression support:
Classification IV
very strong pressure (>40 mmHg)
Types of compression bandages
Non stretch
short stretch
long stretch
Describe Unna boot
paste and impregnant with zinc oxide, glycerine, gelatine,calamine
Dries to form a semi-rigid dressing
How often do you want to change the Unna boot
7-10 days
describe the four layer bandage system
spirally wrapped orthopedic wool to absorb exudates and protect bony prominences
spirally wrapped cotton crepe bandage
highly elastic conformable compression bandage applied to a figure 8 with 50% overlap
spirally wrapped elastic cohesive bandage to hold the layers in place
T/F: once an ulcer is healed compression is a lifelong daily therapy for individuals with chronic venous insufficiency
True
what is the peak pressure of the intermittent compression pump
45-60mmHg
how often is the intermitten compression pump used
1-2hr/twice a day
what are the contraindications for intermittent compression pump
arterial insufficiency
edema due to CHF
local infection
acute thrombophlebitis
DVT